直径〉1．0cm的甲状腺乳头状癌多种CT征象的多因素分析

Multiple-factor analysis of CT signs of PTC greater than 1 cm in diameter

目的对比多种CT征象在直径〉1.0 cm PTC和结节性甲状腺肿（nodular goiters，NG）中的分布，通过多因素Logistic回归分析，统计多种CT征象在PTC中的诊断价值。方法回顾性分析经组织学证实的277例288枚直径〉1.0 cm的PTC的CT表现，包括结节形态、咬饼征、微钙化及增强后范围缩小/模糊，并与同期直径〉1.0 cm的231例276枚NG的CT征象相比较，通过多因素Logistic回归分析对多种CT征象进行统计，并计算阳性CT征象及其联合在PTC诊断中的敏感度及特异度。结果多因素Logistic回归分析显示，结节形态不规则、咬饼症、微钙化及增强后范围缩小/模糊均更常见于PTC中，OR值分别为17.249（95% CI 8.954~33.227）、23.697（95% CI 11.653~48.188）、4.536（95% CI 2.031~10.132）、4.672（95% CI 8.954~8.999）,单一CT征象诊断PTC的敏感度和特异度分别为31.3%~82.3%和83.3%~93.1%，3种或42种CT征象组合诊断PTC的敏感度和特异度分别为24.0%~70.5%和96.7%~100%，CT征象组合诊断PTC的敏感度和特异度分别为19.1%~61.5%和99.6%~100%。结论尽管结节形态、咬饼征、微钙化及增强后范围缩小/模糊是诊断PTC的重要征象，但多种征象的OR值存在较大差异，对这些差异的准确识别，及联合多种CT征象可明显提高PTC诊断的特异度，从而减少误诊的发生。

ObjectiveBased on contrasting CT signs distributed in PTC greater than 1.0 cm in diameter and nodular goiters （NG） , multiple logistic regression analysis is adopted to make a statistics of what diagnostic value that CT signs have for PTC.MethodsRetrospective analysis of CT findings of 288 PTC with diameter 〉1.0 cm in 277 cases confirmed by histology, including nodular form, cookie bite symptom, microcalcifications and enhanced narrowing/blurring was performed, and compared with CT signs of 276 NG in 231 cases with diameter〉1.0 cm. Analysis of various CT signs were performed by multivariate Logistic regression method, and the sensitivity, specificity of positive CT signs and their combinations in PTC diagnosis were calculated.ResultsMultivariate Logistic regression analysis showed that irregular nodules, cookie bite symptom, microcalcifications and enhanced arrowing/blurring were often observed in PTC, with OR values of 17.249 （95% CI 8.954-33.227） , 23.697 （95% CI11.653-48.188） , 4.536 （95% CI 2.031-10.132） , 4.672 （95% CI 8.954-8.999） , respectively. The sensitivity, specificity of single CT sign diagnosing PTC were 31.3%-82.3% and 83.3%-93.1%, respectively. The sensitivity, specificity of two CT signs combinations diagnosing PTC were 24.0%-70.5% and 96.7%-100%, respectively. The sensitivity, and specificity of three or four CT signs combinations diagnosing PTC were 19.1%-61.5% and 99.6%-100%, respectively.ConclusionsAlthough the nodule form, cookie bite symptom, microcalcifications and enhanced narrowing/blurring are the important signs for diagnosing PTC, the OR values of various signs had great difference. The accurate identification of these differences and various CT signs combinations can further improve the specificity of diagnosing PTC, thus reducing misdiagnosis.